Medical Oncology
Physician insights on cancer treatment protocols, immunotherapy, targeted therapies, and clinical trial updates.
Recent Discussions
What are alternative myeloma therapies for patients who are unable to afford lenalidomide or oral cyclophosphamide due to gaps in prescription drug coverage?
Unfortunately, this is a big problem, especially in community centers where the resources for grant applications are scarce. At bigger institutions, like ours, we have a dedicated person who searches for all possible grants. If unable to, then the pharma companies have been generous to give free dru...
What are alternative myeloma therapies for patients who are unable to afford lenalidomide or oral cyclophosphamide due to gaps in prescription drug coverage?
Unfortunately, this is a big problem, especially in community centers where the resources for grant applications are scarce. At bigger institutions, like ours, we have a dedicated person who searches for all possible grants. If unable to, then the pharma companies have been generous to give free dru...
What is the recommended approach for a 7 cm x 5 cm paraspinal subcutaneous desmoid tumor (T6 to T9) incidentally detected on PET CT during NSCLC monitoring, with confirmed growth over 18 months?
Medical management is the preferred treatment for patients with desmoid tumors when the DT either causes symptoms (pain, deformity) or has confirmed growth by RECIST criteria over at least 6 months. If this patient has a DT that is worsening over 18 months and threatens the integrity of the spine, t...
What could explain the contradictory results between CheckMate 274, IMvigor010, and AMBASSADOR?
The reasons for the discord between the results of IMvigor010 and CheckMate 274 are unclear and may be multifactorial. In the IMvigor010 trial, the primary endpoint of DFS was not met with adjuvant atezolizumab vs. observation in the ITT population (HR 0·89 [95% CI 0·74-1·08]; p=0·24). The median DF...
For patients with essential thrombocythemia already on prophylactic dose DOACs, do you defer starting aspirin?
I usually defer aspirin in these situations. There is evidence from PV that aspirin plus anticoagulation increases bleeding risk (Zwicker et al., PMID 34162181). If an ET patient has a high-risk disease with prior arterial thrombosis, then I would favor adding aspirin.
Does evidence support extending the duration of intravenous iron dextran (INFeD) infusion in pregnant patients?
No, there has never been evidence with any of the four formulations supporting a longer rate of infusion (above the minimum recommended) as a harbinger of either benefit or safety. LMW ID (INFeD) should be given as 1000 mg in 250 ml of normal saline over one hour. My gut tells me 45 minutes is OK bu...
Does evidence support extending the duration of intravenous iron dextran (INFeD) infusion in pregnant patients?
No, there has never been evidence with any of the four formulations supporting a longer rate of infusion (above the minimum recommended) as a harbinger of either benefit or safety. LMW ID (INFeD) should be given as 1000 mg in 250 ml of normal saline over one hour. My gut tells me 45 minutes is OK bu...
Would you offer consolidative radiotherapy for oligometastatic NSCLC?
These are extremely challenging cases and the recent negative studies have somewhat dampened my enthusiasm. It has been challenging, in general, to obtain authorization for treatment in these cases and the release of this data will not make it any easier. And as experts note, there are multiple bin...
Would you transition from denosumab to anabolic agents in patients who are in urgent need for extensive dental work?
From my experience, this is a catch-22. If you stop the Denosumab you will markedly increase osteoclastic activity throughout the entire skeleton which is why it is recommended that you not stop the medication without some other intervention. I have had several patients with either osteonecrosis of ...
How do you counsel patients with acute intermittent porphyria when it comes to fasting for religious reasons?
This is a very difficult question and it depends on the individual patient, their disease severity, their particular triggers, and how they have done in the past with caloric restriction. The patient may want to speak with a clergy member for guidance in this situation as well. For inst...